Healthcare Provider Details

I. General information

NPI: 1982478178
Provider Name (Legal Business Name): MR. HAYDEN GUNTHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E BROADWAY
COLUMBIA MO
65215-0001
US

IV. Provider business mailing address

1200 E BROADWAY
COLUMBIA MO
65215-0001
US

V. Phone/Fax

Practice location:
  • Phone: 573-442-2211
  • Fax:
Mailing address:
  • Phone: 573-442-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number340351
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: